• Clinics in Shoulder and Elbow
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• v.1 no.1
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• pp.40-45
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• 1998

Multidirectional instability of the shoulder joint is an unusual entity which is not yet well understood. Traditionally recommended treatment is non-operative, but recently arthroscopic treatment has been performed. This is a retrospective review of 20 patients who had multidirectional instability, who had been treated with arthroscopic capsular shift(7 cases), and arthroscopic treatment using Ho:YAG laser(l3 cases) at Department of Orthopaedic Surgery, Chungnam National University Hospital from July, 1988to February, 1997. Results of this study were as follows: 1. In five patients who were treated with arthroscopic anterior capsular shift only, all cases had redislocation of the shoulder joint. But there was no redislocation in two patients who were treated with arthroscopic anterior and posterior capsular shift. 2. ln three patients who were treated with laser-assisted capsular shift only, all cases had redislocation of the shoulder joint. But there was only one redislocation in ten patients treated with laser-assisted capsular shrinkage and capsular plication. Ho: Y AG laser has been found to be a safe and efficacious adjunct to many arthroscopic shoulder procedures. We had satisfactory results by combining a transglenoid capsular shift with laser-assisted capsular shrinkage. Arthroscopic laser-assisted capsular shrinkage and capsular plication is a one of recommendable treatment options in multidirectional instability of the shoulder joint.

• Journal of Korean Foot and Ankle Society
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• v.6 no.1
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• pp.100-105
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• 2002

Purpose: The purpose of this study is to report four operative cases of recurrent peroneal tendon dislocation being effectively treated by superior peroneal retinaculum reconstructive operation and rerouting of calcaneofibular ligament. Materials and Methods: Four male adults with recurrent peroneal tendon dislocation including one of patient with redislocation after the treatment of plication of inferior peroneal retinaculum were followed up after being treated with superior peroneal retinaculum reconstructive operation using Achilles tendon and rerouting of calcaneofibular ligament. Results: All patients followed up for over one year revealed no pain and no redislocation. One patient who experienced redislocation after the treatment of plication of inferior peroneal retinaculum had no other complication after the treatment of superior peroneal retinaculum reconstructive operation using Achilles tendon. Conclusion: The reconstructive operation presumed to be effective for recurrent peroneal tendon dislocation.

• Clinics in Shoulder and Elbow
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• v.11 no.2
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• pp.172-176
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• 2008

Purpose: The proper surgical methods for treating acromioclavicular joint dislocation is still controversial. New methods should provide better early motion with sufficient strength. Materials and Methods: We performed arthroscopic stabilization using TightRope$^{(R)}$ (Arthrex, Inc, Naples, FL) in 10 cases of acromioclavicular joint dislocation between April, 2007, and December, 2007, and followup for a minimum of 10 months. We performed radiologic evaluation by comparing the clavicle anteroposterior radiograph with the contralateral one. Clinical evaluation was made for pain, function, and range of joint motion by Imatani's methods. Results: In clinical evaluation, 6 cases were excellent, 3 cases were good, and 1 case was poor. In radiologic evaluation, 9 cases were excellent and 1 case was poor. Redislocation occurred in 1 case. Conclusion: During short-term followup, 9 of 10 patients who underwent arthroscopic stabilization using TightRope$^{(R)}$ had excellent results in Imatini tests and radiologic evaluation, except 1 patient with redislocation.

• Journal of the Korean Arthroscopy Society
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• v.9 no.2
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• pp.186-193
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• 2005

Purpose: To determine whether it is possible to differentiate between ALPSA(anterior labroligamentous periosteal sleeve avulsion) lesion and Bankart lesion using arthroscopic findings and to investigate the clinical significance of ALPSA lesion. Materials and Methods: This study was performed on 66 cases that underwent arthroscopic Bankart repair for the anterior instability of the shoulder. By the readings of MRI, there were 56 cases(85%) of Bankart lesion and ten cases(15%) of ALPSA lesion. Arthroscopic findings of Each cases were classified and their average follow-up period was 22 months. Results: It was observed that ALPSA lesions developed in younger age groups than Bankart lesions. Under the arthroscope, ALPSA lesions showed various forms, especially there were five cases of severe inferomedial displacements. Within Bankart lesion, 21 cases were observed to be severely displaced and from the arthroscopic findings, it was difficult to distinguish the difference of Bankart lesion cases displaced inferomedially from the neck of scapula without severe lateral displacements and ALPSA lesion. Regarding the recurrence, there were no redislocation but apprehension shows in two cases(20%) with severe inferomedial displacement in ALPSA group. In Bankart lesion, there were four recurrent cases(7.1%); one of redislocation; one case of subluxation; two of apprehension. Conclusion: It was difficult to differentiate Bankart lesion and ALPSA lesion with severe inferomedial displacement and severely displaced ALPSA lesion showed high rate of recurrence. Thus, complete detachment of ALPSA lesion should be performed more carefully to reduce the recurrence rate.

• Clinics in Shoulder and Elbow
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• v.11 no.1
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• pp.46-52
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• 2008

Purpose: This study examined the outcomes of reconstruction of the coracoclavicular ligaments with using two suture anchors and performing coracoacromial ligament transfer in patients with acromioclavicular dislocation. Material and methods: Forty patients with complete acromioclavicular dislocation were included in this study. According to the preoperative radiographs, 5 patients with AC dislocations were diagnosed as type III, 4 patients as type IV and 31 patients as type V. Two 3.5mm suture anchors with four strands of nonabsorbable sutures were separately placed on the anterolateral and posteromedial portion of the base of the coracoid process to stabilize the distal clavicle. The coracoacromial ligament was then transferred to the undersurface of the distal end of the clavicle for augmentation. Results: At a mean follow-up of 28 months, the average Constant score improved to 97 points. All the patients returned to normal life at an average of 3.2 months postoperatively. At the last follow-up, 37 patients achieved anatomical reduction and three patients showed complete redislocation. However, the clinical results of the patients with redislocation were satisfactory. Conclusion: Anatomical coracoclavicular reconstruction using two suture anchors and coracoacromial ligament transfer for treating complete acromioclavicular dislocation is a safe, effective procedure for restoring a physiologically stable acromioclavicular joint.

• Clinics in Shoulder and Elbow
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• v.19 no.2
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• pp.110-116
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• 2016

Background: Arthroscopic surgical repair is a better intervention than non-operative (conservative) treatment for patients with shoulder dislocations. This systematic review determined the numbers-needed-to-treat (NNT) and relative risk reduction (RRR) associated with arthroscopic surgical repair versus non-operative treatment in reducing recurrence rates among patients with first-time traumatic anterior shoulder dislocations. Methods: We searched Google Scholar, MEDLINE, SPORTDiscus, and CINAHL from inception in 2015. All articles had to compare arthroscopic surgical repair and non-operative treatment and be written in English. We used the total number of subjects and the number of recurrent dislocations within each treatment to calculate the NNT and RRR for each study and the pooled data. Results: Six articles were selected and all clearly demonstrated that the arthroscopic surgical repair was more effective than non-operative treatment in reducing the recurrence episodes. The pooled NNT was 1.76 (95% confidence interval [CI]=NNT to benefit 1.50-2.13) and the pooled RRR was 86.0% (95% CI=77.0%-92.0%) among individuals who underwent arthroscopic repair. The average follow-up time was 56 months. Conclusions: A Strength of Recommendation Taxonomy level of evidence of 1 with a grade A recommendation supports the use of arthroscopic surgical repair over non-operative treatment in prevention of first-time traumatic anterior shoulder dislocations. We suggest that sports medicine practitioners consider the patients' age, occupation, and physical activity level when making a clinical decision.

• Journal of The Korean Dental Society of Anesthesiology
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• v.13 no.3
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• pp.121-126
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• 2013

Temporomandibular joint (TMJ) dislocation is an acute paintful condition that causes severe functional limitation. So, manual reduction is the treatment of choice and should be performed as early as possible. Long-term dislocation of the TMJ that has persisted for more than 1 month is comparatively rare. This may include severe illness, neurological diseases and prolonged intensive care hospitalization with oral intubation and sedation. A joint that remains prolonged dislocated undergoes morphological change which is also true for periarticular tissue, especially in ligaments and muscles. Treatment of long-term TMJ dislocation should be different from acute TMJ dislocation, as simple reduction is difficult to achieve and it's likely to redislocate. The prevention of redislocation after reduction should be considered. This is a case report of about manual reduction of temporomandibular joint long-standing dislocation under general anesthesia.

• Clinics in Shoulder and Elbow
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• v.3 no.2
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• pp.79-86
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• 2000

Purpose: We analysed the clinical efficacy of inferior capsular shift operation in multidirectional instability of the shoulder joint in terms of functional aspects and patient's satisfaction Materials and Methods: From July, 1998 to March, 2000, we treated 23 cases of multidirectional instability of the shoulder joint with T-shaped inferior capsular shift and/or Bankart repair. All of them have complained of an experience about frank dislocations. Two of them has a voluntary component. We evaluated them according to complication, function, range of motion, stability and patient's satisfaction with an average follow-up of 15 months(the range of 9 to 27 months). Results: Eight cases were atraumatic multidirectional instability and coexisting Bankart lesion were present in 15. There was no redislocation, but one case of symptomatic subluxation, 3 cases of transient nerve palsy and 2 cases of feeling of laxity developed. Limitation of motion after surgery was an average of 3.4° in flexion, and 8.5° in external rotation. With Rowe scoring system, the clinical result was excellent or good in 22 cases and poor in one. According to American shoulder and elbow society, pain score improved to 1.4 from 6.1, and stability score also improved to 1.8 from 9.1. Conclusion: In multidirectional shoulder instability, one should pay attention to finding a coexisting Bankart lesion. In that case, adequate capsular volume reduction by using inferior capsular shift as well as repair of Bankart lesion is needed to get a good surgical outcome.

• Clinics in Shoulder and Elbow
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• v.5 no.1
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• pp.47-54
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• 2002

Purpose : We evaluated clinical result of arthroscopic and open Bankart repair in anterior shoulder instability to identify factors iuluencing operative result and prognosis. Materials & Methods . We reviewed 24 patients of anterior shoulder instability treated with arthroscopic Bankart repair in 16 cases and open Bankart repair in 8 cases. Average age was 26 years old and involved in dominant arm in 15 cases. Patients were suffered instability for 3.1 years before operation and mean follow-up was 2 year 9 months ( 1 you 9 months -4year 10 months). Results : Post operative pain was subsided in 2 weeks in arthroscopic surgery and 3 weeks in open surgery. The final range of motion after arthroscopic repair were flekion in 168" , external rotation in 54" , and internal rotation in 79, and after open repair 168" ,49" , and 78 respectively. In arthroscopic surgery,2 cases (13%) were redislocated, and 4 cases(25%) showed mild instability. In open case,1 case (11%) showed mild instability. According to function- al result by Rowe grading scale, satisfactory results were 12case (76%) in arthroscopic repair and 7 cases (88%) in open cases. Conclusions Both arthroscopic or open Bankart could get good results in the treatment of anterior instability of shoulder. In arthroscopic repair, perioperative morbidity was lower than open repair, but it needs careful rehabilitation program to prevent redislocation and to return to sports activity.

• Clinics in Shoulder and Elbow
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• v.7 no.2
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• pp.98-102
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• 2004

The terrible triad of the shoulder, a combination of anterior shoulder dislocation, massive rotator cuff tear and neurologic injury, is rare. We experienced 4 patients with this condition who were treated with a rotator cuff repair. The mean age was 65 years. Follow-up averaged 27 months. All patients had a history of redislocation after initial traumatic shoulder dislocation and were evaluated with electromyography and magnetic resonance imaging. At the operation, massive rotator cuff tear and hypertrophy of the long head of the biceps were found in all patients. Clinically, 3 patients achieved recovery of their nerve injury by 3 months postoperatively and the final results were fair. In one patient, there was no recovery of deltoid function and this case was rated as a failure. For this injury pattern, the prognosis appears to be dependent on eventual nerve recovery when the rotator cuff has been repaired early.